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Underground Storage Tank System Tanks, Piping, &SpiH Buckets 7 <br /> Page of <br /> Secondary Containment Certification Form <br /> Testing Contractor: �CZDvI Test Date: 10-21�OZ m <br /> Fatuity#: 3(0 35 city: S�oc1�-�oln g m <br /> N <br /> Facility Address: f 464x5 SOr•� Stt..�G Qor,, t: �°l Contractor Address: 141105.Tu.ert -iil00J '+�'�/2- Tech. Name:$ I�+�� 13yw�2. <br /> cn <br /> i cn <br /> USTAnnrdarS ace Seconda P' in <br /> Tank NJ Tank #2 Tank#3 Tank#W <br /> Line <br /> Line #2 Line#3 Line <br /> Product 87 89 91 D 87 89 91 D 87 89 91 D 87 89 91 D Product 87 990D 87 99 91 D 87 89 91 D 87 B9 91 D m <br /> • Piping Type rim Siphon Primary Siphon Primary Siphon Primary Siphon <br /> Capacity <br /> n <br /> Manufacturer Manufacturer L)ht;nm A <br /> Tesiin'e Test Start Time <br /> Initure Initial Pressure CJ,O Q•S,S <br /> Tesme Test End Time 9;3(o <br /> Finre Final Pressure •0 Q•S,T <br /> Test Results Pass Fail Pass Fail Pass Fail Pass Fai] Test Results ass Fail Pass Fail Pass Fail Pass Fail <br /> M <br /> M <br /> Signature Signature n <br /> 0 <br /> S <br /> � <br /> ill Buckets <br /> Overfill#1 Overfill#Z Overfill#3 Overfill#4 <br /> Second Pi in M <br /> Line#5 Line 46 Line 97 Line#8 = <br /> • Product 87(!5)91 D 87 8907D D ( 89 91 D 87 69 91 D Product 87 89 91 D 87 89 91 D 87 89 91 D 87 89 91 D <br /> z <br /> Manufacturer <br /> VA(tp L O piping Type Primary Siphon Primary Siphon Primary Siphon Primary Siphon <br /> Start Time(to) Z'95 8'w e'er <br /> Water Level .000 .000 '000 <br /> Manufacturer <br /> Time ltr) '58 %:13 Test Start Time <br /> Water Level .006 00 1000 <br /> 0 1 Initial Pressure <br /> ( <br /> Time(tz) a t(. 8' <br /> Water Level .000 DOD .000 Test End Time <br /> Time(Q 8:0'I S%14 la'3'f Final Pressure <br /> Wager Level .00D pOq DOa D <br /> Test Re Pass Fail Pass Fail Pass Fail Pass Fail b <br /> Time(t6) <br /> x;07 L3 %b7 m <br /> Water Level .000 ,000 OOD Signature co <br /> � taN m <br /> Test Results Fail Fail ass Fail Pass Fail <br /> A <br /> signature <br />